the best results in acquiring good articulation, and in On motion of DR. PRINCE a vote of thanks was that respect surpasses anything which I have seen. tendered to the retiring chairman, DR. GEORGE B. I do not think Dr. Baker did it justice in his remarks SHATTUCK, for the zeal and fidelity with which he has upon it; for he must have known that if it was prop- conducted the deliberations of the Section during the erly made the die in which it was made was a perma- past two years. nent mould which rendered the vela capable of easy and limitless duplication, and so easy of adjustment that it could be sent to any part of the world, or, if necessary, made or duplicated by any dentist who would follow the directions which accompany it. The cleanliness depends upon the individual, as does the cleanliness of anything worn about the person. The best results are dependent solely upon skillful manipulation, and no appliance can be successfully adapted by an unskilled hand. There can be no fixed rule to follow; each case presents new features, which must be met as they appear. My preference is for the soft rubber, because it more readily fulfills the requirements, and because it has done better work than any appliance which I have yet seen, though I have seen a few cases in which the hard rubber obturator had proved very beneficial. I will not intrude further upon your time than to say that one of my greatest complaints against the Suersen principle has been that it seems almost impossible to obtain a clear voice with it, a fact which I have attributed to its thickness obstructing the posterior portion of the nares, and in Dr. Baker's appliance I cannot see that the hinge obviates that difficulty. Adjourned at eleven o'clock. PATHOLOGICAL SOCIETY OF PHILADELPHIA. C. B. NANCREDE, M. D., RECORDER. THURSDAY evening, January 10, 1884. The President, DR. TYSON, in the chair. OSTEO-MYELITIS OF TIBIA. Exhibited by DR. C. M. WILSON. G. L., aged forty-two, was admitted into the surgical ward of the Pennsylvania Hospital November 26, 1883. Sixteen days previously he had been knocked down on shipboard, and had sustained a wedge-shaped fracture of the tibia and an oblique fracture of the fibula of the right leg about the middle. When admitted the fragments were in malposition and partially united. There was considerable deformity, the lower fragment of the tibia being tilted up and overlapping the upper fragment. By appropriate treatment the fracture was retained in fairly good position, and the case was progressing favorably until the afternoon of December 26th, just one month after admission, when he had a severe chill, followed by a temperature of 103.5° F. He complained of violent pain in left shoulder-joint. He was treated with salicylate of sodium. Next morn. ing his temperature was 102.5° F., with intense pain in both shoulders and elbows. The same anti-rheumatic treatment was continued under the supposition that the case was one of acute articular rheumatism, the man having been exposed to a draught. The afternoon of second day he had a severe chill, with an evening temperature of 101.4° F., and a presystolic mitral murmur was detected. Dr. Wilson now considered the case to be one of pyæmia, and gave massive doses of quinia, stimuli, and digitalis. The man steadily grew worse, and died of exhaustion on the morning of December 30th. The patient was then introduced, and the appliance could be seen in the mouth, and, by causing him to swallow, the relation of the instrument to the wall of the pharynx and to the ale of the velum palati could be easily observed. It was evident that in the act of deglutition no communication between the nasal cavity and the pharynx existed, the posterior part of the obturator being raised up by the superior constrictor muscle of the pharynx, and pressed firmly against the posterior wall of the pharynx at the line of the nasopharyngeal junction. The patient now removed the appliance, when an enormous fissure was disclosed, extending from a point near the incisor teeth through the entire hard palate and velum. Upon being asked to read, it was quite impossible to understand what the patient was saying. After replacing the appliance the same sentences were read, and every word was spoken with great distinctness, and could be easily understood by every person present. After this the patient was asked to read some new selection, and opening a book at random, commenced as follows: "Physicians generally agree that the moderate use of wine is beneficial." At this point the audience, pleased with the improvement in speech, and possibly desiring to express approbation of what was read, burst into applause, and appeared to be perfectly satisfied as to the usefulness of this instrument in cases of cleft palate. The patient remarked that he found the greatest comfort and solace in the fact that with the appliance inflammation. his mouth he was able to smoke, while without it he could not draw the vapor of the tobacco from the pipe into the mouth. With it, also, he can whistle, which he cannot do without it. On motion of DR. MARCY it was voted that the thanks of the Section be rendered Dr. Baker for his important communication of original studies upon a most difficult subject and demonstration of ingenious mechanical appliances for the remedy of cleft palate. Post mortem twenty-six hours after death. Rigor mortis marked. Body well nourished. Posterior portion of body much discolored; extensive ecchymoses over arms and shoulders. Smaller patches over abdomen and chest. One and one half ounces of clear serum in the pericardial sac, with many ecchymoses over the surface of the heart. Both sides of heart relaxed and partially filled with post-mortem clots. The valves on right side appeared normal. The aortic valves were incompetent, and their free borders were roughened by recent vegetation. There was also some slight thickening and contraction. The mitral valves showed old thickening as well as signs of recent inThe endocardium of the left ventricle showed numerous spots of ecchymoses. The heart weighed sixteen ounces, and its tissue was a good deal softened. Spleen normal. Left kidney weighed seven ounces, was somewhat swollen, and its tissues were slightly flabby. The capsule was thickened and somewhat adherent. The organ was congested and somewhat swollen. Right kidney weighed six ounces, and presented the same appearances as the left. Liver was large, swollen, and marked by the ribs. Its surface Accent Literature. was mottled with rounded yellowish patches surrounded by dark-red areola. Section showed it to be markedly congested. Its weight was four pounds four ounces. Lungs much congested. The base of the A Manual of Psychological Medicine and Allied Nerleft being anteriorly bound down by old adhesions. vous Diseases. By EDWARD C. MANN, M. D. The brain was not examined. Examination of the Philadelphia: P. Blakiston, Son & Co. 1883. fracture showed it to be ununited, and there was no callus detectable. The periosteum tore easily. On secThis book on insanity comprises 700 full-grown tion the medullary cavity of the tibia showed marked pages, to say nothing of some illustrations. Why it evidences of inflammation. There was a puffy septum should be called a "manual," unless because it was of granulating tissue between the ends of the frag-written by Mann, we are at a loss to see, as Worcester ments. Above there was evidence of extravasated defines a "manual as a small book, such as can be blood, and two and one half inches above the line of carried in the hand," and this book is large enough to fracture there was a small circumscribed medullary ab- be carried around in a shawl strap. The original conscess. The medullary cavity was inflamed and streaked tents, however, if boiled down, would easily go into the vest pocket. with red lines. Through the kindness of Professor Brinton and Dr. Longstreth, Dr. Wilson was enabled to show several pictures illustrative of osteo-myelitis. This is the only case of death from simple fracture recorded at the Pennsylvania Hospital. This disease must be a very rare sequel of simple fracture. It is not necessarily a fatal disease, as the inflammation may become circumscribed, a depot of pus formed, and the destructive processes end there, or a portion or the whole of a bone may die or be removed. It is easy to see how a virulent inflammation going on to suppuration with no vent to the pus, as in this specimen, could readily give rise to septic poisoning. I am indebted to the courtesy of Dr. Longstreth both for the specimen and assistance in its preparation. DR. TYSON said that he had seen many cases of osteo-myelitis from gunshot injuries during the late war, but he could not recall a case where the medullary canal was encroached upon by a condensing osteitis, as in this specimen. DR. NANCREDE related a case of fatal septic trouble following a simple fracture of the thigh, where the starting point seemed to him to have been a superficial ulceration of the skin, produced by the adhesive plaster. Possibly section of the bone might have revealed an osteo-myelitis, but as the fracture was firmly united, be thought that the skin abrasion was the starting point, and related two cases of pyæmia produced by equally trivial causes. DR. LONGSTRETH related a case seen by him when a resident physician at the Pennsylvania Hospital. The patient had a fracture of the thigh of three weeks' standing, and was apparently doing well, when chills, sweats, lung consolidation, etc., etc., ushered in a fatal attack of pyæmia. A post mortem revealed osteomyelitis and general pyæmic manifestations. A sible explanation of Dr. Wilson's case was that the man had been on board ship for three weeks after his injury, where the treatment must have been of the crudest description. pos DR. ESKRIDGE called attention to the endocardial trouble found in septic disease, which he had been taught as a student to consider was of an ulcerative form, and of fatal prognostic import. He had, however, seen two cases which presented all the symptoms of ulcerated endocarditis, but which had recovered, while in two others with a similar clinical history postmortem examination revealed only a simple non-ulcer ative endocarditis. DR. SHAKSPEARE asked whether this condensing osteitis might not have been due to a previous syphilitic trouble. 66 Dr. Mann has adopted the old-fashioned plan of bringing together a large amount of material from a great variety of very good authors, and has strung this together on a slender and often invisible thread, and with so little zusammenhang that sometimes there is little relevancy. His History of Insanity covers one page. Next he begins on Classification, recommending the simple and childish system of Krafft Ebing. This covers two pages. On the middle of the next page he branches into the making of autopsies. On the next page he gives definitions of insanity until he suddenly remembers that he was on the subject of classification, and returns to this again toward the bottom of the page. After a short chapter on the Etiology of Insanity, he has a chapter of two pages on the Prevention of Insanity. Why he breaks in on the usual custom followed, and puts in a few words just here on this subject instead of at the end of the book, he does not say. Chapter IV. has nineteen pages on the Diagnosis and Prognosis of Insanity. Chapter V., sadly out of place, has eight pages on Civil Incapacity. Chapter VI. has nine pages on General Paralysis of the Insane, of which Dr. Mann has the very correct idea that it should be called general paralysis because it is no paralysis in particular. Chapter VII. treats of Idiocy, Dementia, Folie Raisonnante (Syn., Moral or Affective Insanity)." After a chapter on Mental Responsibility, etc., in Criminal Cases comes a chapter on The Histology and Functions of the Cerebrum. These specimens of the arrangement of the book will show with what incongruity and lack of system the book is written, and as these faults are combined with those of general incompleteness and a marked lack of thoroughness of treatment of most of the subjects discussed we should say that time would be utterly wasted in reading the book. We regret the necessity, but it becomes our solemn duty, in the interests of good psychological writing, to openly declare that this book, in our opinion, is a complete failure. Medical and Surgical Journal. and officer were deceived by the "Jewish surgeon," THE SIMULATION OF STONE. FEIGNED diseases form an exceedingly interesting class of cases, though the majority of malingerers fall under the notice of the military and naval rather than of the civil surgeon. In times of general conscription such attempts at fraud are most frequent, and show the greatest ingenuity on the part of the malingerers, calling for equal acuteness for their detection. In France the time of the first Empire was most prolific in such attempts to escape military duty, and many will recall the published lists of the exempt and the disease on which their exemption was founded during the conscription at the close of our late civil war. But even the quietest and least suspicious of civil practitioners is liable to be deceived, as some of the most carefully studied attempts at deceit have been devised and executed without the exciting stimulus of the desire to avoid military duty. One of the most baffling cases was given in this journal some three years ago of the "dummy chucker," or executor of epileptic fits, for the opportunity offered to his accomplices, during the excitement attendant on the fit, of robbing the bystanders. Few cases are so skillfully executed as in the case of this criminal, who boldly "chucked his dummy" in the court room and in hospital wards. The feigned diseases embrace a wide list of subjects, and under the same general heading which includes the fraud who simulates a disease which he has not must be classed the individual who, wounded or sick, exaggerates the gravity or conceals the cause of the complaint. An important contribution to the literature of feigned diseases has recently been made by Dr. Brongniart, of Contrexéville. He narrates three cases, all females, which have come under his own observation, in which the pretense was made that stones had been passed from the bladder, and these pretended calculi were preserved and exhibited. Twenty-two similar cases are referred to as found in the literature of the subject, of which one was a man, four were boys, and the rest females. The only adult male case is one narrated by Civiale of an officer who claimed to have been cut for stone just after the retreat from Moscow. The stone that he exhibited was remarkable for its size and polish; a section proved it to be but a common pebble. Reverence for the great lithotomist forbids us to intimate the possibility that both narrator who desired to retain the fruits of his own prowess The three cases of Brongniart have little if any Suppose that the doctor has, from some point in the appearance of the gravel, a doubt of its authenticity, which is converted into certainty by chemical analysis, shall he consider it as an ordinary deception without motive? tient's sufferings? Shall he reject as false all the pa Our author does not believe it. It is one's duty, on the contrary, to inquire carefully into the history and heredity of the patient, and if hysteria is manifest in herself or her parents he will perhaps find that the simulation is the consequence of a painful form of hysteria, of a nephralgia, or a cystalgia, of which the real pain must not be overlooked by the discovery of the added deceit. Various authors are cited to show that hysteria may provoke painful phenomena and functional trouble on the part of the urinary organs. One can then easily imagine that a nervous woman, perfectly honorable, without a premeditation of deceit, may be attacked with a hysterical nephralgia so resembling nephritic colic as to deceive even the attending physician. "All the world," commencing with the patient, believe in the existence of the gravel; but after many returns of the attack and no appearance of anything to confirm that opinion one begins to doubt the truth of the diagnosis. The terms "nervous attack," "hysterical crisis," come to the ears of the patient, and to avoid the unpleasant name hysteria she takes pains to demonstrate at her next attack the reality of her pain. A course of deception once entered upon she will not willingly inculpate herself, and the deception may be continued for months and even years. One of these cases must serve as a sample of the class. Mlle. B., eighteen years of age, slightly chloroanæmic, was subject to various nervous accidents. These nervous attacks were attended with very acute lumbar and abdominal pain, difficulty of micturition, and convulsive movements. Having had occasion to assist in the care of an aunt suffering from nephritic colic, Mlle. B., after one of her painful crises, showed gravel which she said she had found in her urine, and more was found in her bed. There was no longer doubt in the mind of her physician as to the character of her disease; she had nephritic colic, and was sent for treatment to Contrexéville. The young girl belonged to an excellent family, and there was no reason to suspect the truth of the story, but the father had brought with him and showed to Dr. Brongniart the gravel, which was seen to be made up of particles of quartz and fragments of brick. At a private interview, the father refused entirely to believe in the Dr.'s explanation, and the suspected gravel was forwarded to Dr. Méhu at Paris for examination. An answer was returned which convinced the father, who became vehement in denunciation of the falseness of his daughter, whose defense the doctor was obliged in his turn to undertake. He told the angry parent that the pains suffered by his daughter were real, that the nervous crises were not simulated, but that they were of a hysterical nature, and that hysterical people were often uncontrollably impelled to reprehensible acts, as, for instance, simulation or theft, without it being possible to consider them actually responsible for these unhealthy impulses. This was a ray of light for the unhappy father, who then revealed certain facts in the history of the mother of the young deceiver, who had been the victim of kleptomania, taking the most worthless objects, necessitating her temporary detention in an asylum. This nervous heredity explained and excused to a certain extent the simulation of which the young lady was rendered guilty under the combined influence of an imitative impulse and the neuralgic pains of hysterical character. The urine, though often examined, was always found absolutely normal in this case. A suitable regimen was prescribed, and nothing more was heard of the case. Our limited space permits us only to add the conclusions which Dr. Brongniart draws from his consideration of the subject: The simulation of urinary gravel observed sometimes in young boys is much more frequent among females. The motive for that deception in boys may be that of all other deceptions, idleness, the desire of exciting interest and pity; perhaps erotic motives. In women and girls the same motives may exist as in boys; much more likely in them are erotic motives as a determining cause. Nevertheless, outside of all depravity, the simulation of urinary calculi may be determined by hysteria under the form of nephralgia: with the purpose of evading the ill-sounding epithet of hysterical, these invalids prefer to give to their sufferings the name of nephritic colic, which induces them to show the fictitious stones. One ought always to analyze with care the urine and gravel from young boys and nervous women who declare themselves afflicted with stone. BOSTON'S IMPROVED SEWERAGE SYSTEM. ON the first day of January the new system of intercepting and delivering sewers for that part of Boston situated between the Charles and Neponset Rivers, which has been in construction for a number of years, was inaugurated. Members of the Massachusetts Medical Society will recall that they were invited during the last annual meeting of the Society to inspect the main sewer, and those who did so are somewhat familiar with the system of which it forms a part. As the growth of the city demanded, sewers were built years ago, each emptying at a locality most convenient and least annoying. According to the new plan a series of intercepting sewers has been constructed belting the city and communicating with the older sewers near their mouths by means of small branch or connecting sewers, provided with gates to regulate the flow. The old outlets are to be for the most part kept open, to be used for storm overflows, and those below tide level will be provided with a double set of gates to prevent the tide from flowing in. ous. The great bulk of the sewage is, however, by the new system to be conveyed to a considerable distance from the shore, and deposited where it is believed, and thus far proved, that it will not be obnoxious or injuriThe various intercepting branches converge into one main sewer, which runs in nearly a straight line to old Harbor Point, Dorchester, where there is a pumping station. At this point extensive works have been erected, the first of which is a filth hoist, through which the sewage passes before it reaches the pumping station. The filth hoist consists of two chambers, in each of which are hung, so as to be raised and lowered by winches, open cages through which the sewage flows and which retain any large floating objects that would injure the pumps. They are arranged in pairs, one behind the other, so that one may be in place. while the other is drawn up for cleaning. Four engines, each of a capacity to raise 25,000,000 gallons. in twenty-four hours to a maximum height of fortythree feet, are now in position, and it is designed eventually to double this pumping capacity, allowance having been made for two boiler houses. The outfall sewer extends from near the engine house to the reservoir on Moon Island, a distance of a little more than two and a half miles. The first portion of the outfall sewer, a section of 1200 feet, is the deposit sewer, which is carried into Dorchester Bay on an embankment; the second portion, having a horizontal length of 6970 feet, is the tunnel under the bay in the form of an inverted siphon, at whose entrance is a vertical descent of 150 feet, the level being regained at the farther end by a rise of one foot in six; the third portion extends from Squantum Neck on the farther side of Dorchester Bay to Moon Island, where it connects with a reservoir having four compartments with a total capacity of 25,000,000 gallons, from which the sewage is discharged at ebb tide into deep water by an outlet sewer. The total estimated cost of these sewers for the south side of Charles River, including an allowance of $300,000 for rebuilding and connecting old sewers, was placed in 1876 at $3,750,000. The actual cost has been thus far about $4,500,000, and $750,000 more will be needed, but much of the work proved far more difficult than was expected, and several contractors met with serious losses. The important thing is that the work seems to have been well done, and the system to practically answer the expectations that were formed of it. For the district on the north side of Charles River a main sewer and branches of fifteen miles length with other works, at a cost of more than $3,000,000, will be required, but are not yet contracted for. In addition to relieving the waters of Charles River and its flats, which had become extremely offensive, the present sewers, providing for a constant and uuinterrupted flow of sewage from its entrance to the outfall sewer, deliver the city from the cess-pool tendency of the old sewers; whether the level of the ground-water will be lowered, as was at one time anticipated, it is as yet too early to determine. It will be easily seen that with the surface drainage of the city and the great consumption of water, between ninety and one hundred gallons per head daily, — the sewage, when reaching Squantum or the reservoir on Moon Island, will be extremely dilute, yielding but a small percentage of solid constituents and those of a soluble character. It is not reasonable to anticipate any annoyance from its discharge into deep water on an ebb tide, either to those navigating this outer portion of the harbor or to those occupying neighboring shores; the full sewage product of the district drained is not as yet discharged through the intercepting sewer, but of the large amount which is discharged all trace is dissipated in the ocean even more readily than was anticipated. Whether any other disposition could be advantageously made of this sewage when once delivered at Squantum or at Moon Island is a subject whose discussion we reserve for another occasion. Enough is already known, however, of the working of the present system to permit us to say that those who designed and executed it deserve well of the city, as will doubtless be evidenced in due time by a diminished death-rate, and more immediately by a relief of offended senses. CREMATION IN CHINA. In the last issue of the Chinese Imperial Maritime Customs Medical Reports Dr. A. Henry contributes some remarks upon cremation in that country. Marco Polo repeatedly asserts that the Chinese wherever he traveled were in the habit of burning their dead; on the other hand Chinese historical works make no mention of the practice, and burial is the almost universal custom at present. The books in which the subject of cremation in China is treated only speak of it as being practiced upon the bodies of Buddhist priests and lepers. In only one, however, of the many Buddhist temples at the town where Dr. Henry is stationed are the bodies of the inmates burned after death. The method of incineration is commendable as efficient, æsthetic, and inexpensive; but it is too slow except for Bud dhist priests in China. In the grounds of the temple. is a small dome-like edifice, the interior of which communicates with the open air by a small door only - a charcoal kiln, in fact. The dead priest is placed in a sitting posture inside the dome, and charcoal and firewood are piled around him; fire is applied, and the door is shut until combustion is complete. Children are sometimes cremated, but for superstitious reasons only. When several young children of a family have died in succession the body of one of them is burned under the belief that this ceremony will insure the survival of the next child born to the family. In these cases the body is simply brought to an open field in a box and placed upon firewood which is ignited. China and India are preeminently countries in which a rational system of cremation might be encouraged with much advantage. MEDICAL NOTES. -Patrick B. Tully, a new representative in Congress from California, has introduced in the House a bill refusing the privileges of the mails to the advertisements" of any medical preparation, compound, or prescription, or any punch, bitters, cordial, or similar compound or preparation to be used as medicine or mixed with food, liquor, wine, or other substance used as a beverage or as food or medicine," unless the manufacturers thereof can procure from the Federal Patent Office a certificate that it is not noxious or dangerous to health. The progress of this bill will be watched with interest, but it will doubtless be beset with many difficulties, so that prognosis for its survival should be very guarded. 66 -M. Paul Bert is not, as the sound of his name might suggest, a hyperborean, but a French savant who has made an eloquent" plea against the American hog before the Legislative Chamber. His views on the liability of trichiniasis resulting from American pork are contrary to those of most other leading scientists of Europe. The persistency of his attack and the resulting legislation have opened the eyes of some American traders to irregularities in the composition of French wines and liqueurs of which they were before oblivious. The principal point of medical interest in the argument of M. Paul Bert, however, is his statement that trichiniasis is more frequent in France than generally believed, owing to its being often mistaken for typhoid fever. Though there is an implied compliment to the therapeutic ability of the Frenchmen in that the recent mortality of their so-called typhoid fever exhibits no increase even though it is the result of an average between the mortality of trichiniasis and true typhoid, still as a reflection on the diagnostic and pathological acumen of his countrymen the remarks of M. Paul Bert must have had a frigorific effect. - It is said that the tooth manufacture of the United States amounts to 10,000,000 teeth per annum. There are twelve manufactories, but one of them, founded in 1864, makes half the number. The |